202 Exam 3 Flashcards
Palpable sinuses
frontal and maxillary
ethmoid and sphenoid are too deep to palpate
dry tongue can indicate
dehydration
what are the three salivary glands and know location
parotid (largest)
submandibular
sublingual
structures of the throat
oropharynx
tonsils
nasopharynx
signs and symptoms of dehydration (assess oral cavity)
dry mucous
fissures in tongue
aging adult oral cavity considerations
diminished small and taste
atrophic tissues
dental changes
mouth dryness
tooth loss
care of teeth/dentures
normal nasal mucosa color
red smooth moist
nasal mucosa: allergies
mucosa swollen
gray
nasal mucosa: rhinitis
swollen, bright red, drainage
assess for jaundice at the ___ for individuals with ____ pigmentation
buccal mucosa, dark
should be pink-brownish color
No movement of the uvula
can show there is no gag reflex, don’t want to feed bc high risk for aspiration
normal tonsils
oval shape, rough or granular appearance, visibility: 1+ (can visibly see tonsils) to 4+ (can’t see the uvula)
infected tonsils
bright red and swollen
perforated septum
A hole in the cartilaginous septum
Commonly caused by drug use (cocaine and methamphetamines), chronic infections, or trauma
abnormalities of the lip: herpes simplex I
cold sore that evolve into pustules, which rupture, weep and crust
lasts about 4-10 days
contagious by direct contact
recurrent infections may be brought on by sunlights fever, colds, and allergies
abnormalities of the buccal mucosa: leukoplakia
Lesions are precancerous and Chalky thick white raised patch with defined boarders
Lesion is firmly attached and does not scrape off
Lateral edges of tongue
Caused by chronic irritation of smoking and alcohol use
abnormalities of the buccal mucosa: candidiasis
White cheesy curd like patches (thrush)
It does scrape off, leaving a raw, red surface that bleeds easily
Occurs after use of antibiotics and corticosteroids and in immunosuppressed people (HIV)
abnormalities of the lip: carcinoma
An ulcer with rolled edges, indurated
Grows insidiously and may go unnoticed for months
lesions that is unhealed after 2 weeks should be referred
May have associated leukoplakia
Abnormalities of the oropharynx: acute tonsillitis
Swollen tonsils with white or yellow exudate on tonsils
Accompanied by a severe sore throat, painful swallowing, and a fever over 101
Abnormalities of the oropharynx: pharyngitis
Infection of the pharynx that causes Bright red swollen throat, white or yellow exudate on pharynx, swollen uvula
Accompanied by severe sore throat, painful swallowing, fever over 101
what is an expected finding in darkly pigmented people
bluish lips
Nonsynovial joints
United by fibrous tissue or cartilage and are immovable like the sutures in the skull or slightly moveable like the vertebrae
muscles are ____% of body weight
40-50%
Synovial joints
Freely moveable
Type of joint found where bones are separated from one another and enclosed in a joint cavity. Lined with synovial membrane that secretes synovial fluid (lubricant) which permits movement
Shoulder, hip, elbow, and knee
Skeletal muscles movements
flexion, extension
abduction and adduction
eversion and inversion
rotation
circumduction
elevation and depression
protraction and retraction
pronation and supination
temporomandibular joint
Depressed area anterior to the tragus
Permits jaw function for speaking and chewing
Allows three motions: hinge action to open and close the jaws, gliding action for protrusion and retraction, gliding for side to side movement of lower jaw
Osteoporosis
Decrease in skeletal bone mass leading to low bone mineral density (BMD) increases risk for fractures
more common in (white) women (after menopause)
Rheumatoid arthritis
Chronic inflammatory pain condition possibly started by an autoimmune response
Inflammation of synovial tissue, hyperplasia and swelling leads to fibrosis, cartilage and bone destruction
Joint involvement is symmetric and bilateral with heat, redness, swelling, and painful movement
Osteoarthritis (non-inflammatory)
Degenerative joint disease
Non inflammatory, localized, progressive disorder involving deterioration of articular cartilages
Asymmetric joint involvement commonly affects hands, knees, hips and lumbar and cervical segments of the spine
Uvula should rise with phonation
six cardinal gazes
parallel tracking in both eyes, muscle control
testing for nystagmus or misalignment in eyes
the aging adult eyes
Cataracts
Glaucoma
Dryness
Decrease in usual activities
Presbyopia
loss of central vision
presbyopia
decrease in power for eyes to accommodate (hyperopia or farsighted)
aging adult: loss of central vision
and risk factors
caused by macular degeneration- can cause blindness (peripheral vision is okay)
associated risk with HTN, diabetes, smoking, pesticides, family history, some medications
Osteoporosis
Decrease in skeletal bone mass leading to low bone mineral density
Increased risk for fractures
Occurs primarily in postmenopausal white women
Ankylosis
Stiffness or fixation of a joint
articular disease
ie. arthritis
inside the joint capsule
produces swelling and tenderness around the whole joint
decreases active and passive range of motion
crepitation
is an audible and palpable crunching or grating that accompanies movement
Phalen test
assess for carpal tunnel syndrome
ask person to hold both hands back to back while flexing the wrist at 90 degrees
after 60 secs if the test produces numbness and burning –> + for carpal tunnel
tests for carpal tunnel syndrome
phalen test and tinel sign
when swelling occurs in the knee, you need to distinguish whether it is caused by soft tissue swelling or increased fluid in the joint. comparison with the unaffected knee is important. which tests can you use to aid this assessment
Bulge sign and ballottement
McMurray test
test to check for meniscal tears
if you hear or feel a “click” = + for torn meniscus
lasegue test
confirms the presence of sciatica and a herniated nucleus pulposus
Ortolani maneuver
checks the hips for developmental dysplasia (DDH)
perform a _____ _____ to establish baseline and assess ADLs
functional assessment
Ankylosing Spondylitis
chronic inflamed vertebrae that is in extreme form leads to bony fusion of vertebral joints
affects the spine, pelvis, and thoracic cage (lower back stiffness)
most frequent type of joint dislocation
glenohumeral dislocation
three cranial nerves for extraocular movement: cranial nerve VI
The Abducens innervates the lateral rectus muscle (abducts the eye)
three cranial nerves for extraocular movement: cranial nerve IV
The Trochlear innervates the superior oblique (need it to “cross” your eyes)
three cranial nerves for extraocular movement: cranial nerve III
The Oculomotor innervates all the rest (most of the movement of our eyes)
Snellen eye chart tests
central visual acuity
higher the bottom number = the worst the vision (20/15 is better than 20/200)
age related macular degeneration
loss of central vision caused by yellow deposits (drusen) and neovascularity in the maculla
affects people over the age of 80 and women
fine tune vision is affected (peripheral vision is okay)
risk factors for macular degeneration
HTN, diabetes, smoking, pesticides, family history, some medications
preorbital edema
lids are swollen and puffy, accumulation of excess fluid
common in patients with CHF
anisocoria
unequal pupil size
affects 5% of the population
does not change to light stimuli
indicated CNS dysfunction (head injury, increased intracranial pressure) (medications such as narcotics and opioids)
eye accommodation test
assesses how pupils constrict to near objects
Looking at something far distance (pupils with relax and dilate) then put an object in front of them (pupils should constrict as they look at the close object) then bring closer (pupils converge)
CN 3 and 4
six cardinal gazes indicates muscle weakness during movement and will tell you which cranial nerve is affected
III III
\ /
VI — eye — III
/ \
III IV
pupillary light reflex direct and consensual
direct- look at one eye to see if it constricts with light
consensual- look at BOTH eyes to see if they constrict with light
normal pupil resting size
3, 4, or 5mm
red reflex
this reflex is the normal reflection from the scope light on the inner retina
cataracts will appear as opaque black
myopia
nearsighted
hyperopia
farsighted
open angle Glaucoma
most common type of glaucoma; virtually no symptoms are exhibited.
Vision loss begins with the peripheral vision, which often goes unnoticed because individuals learn to compensate intuitively by turning their heads.
Glaucoma vs cataracts
Glaucoma- condition where a buildup of pressure in the eye causes damage to the optic nerve which is the vital link of the eye to the brain which processes visual information
cataract- change in the lens of the eye; the result is cloudiness as light is prevented from entering the eye properly. (CLOUDY LENS)
Tympanic membrane (eardrum)
separates the external and middle ear, should be translucent, pearly-gray, and reflect light / vibrates from sound waves
Conductive hearing loss
CN VIII
dysfunction of external or middle ear (i.e. foreign bodies, perforated TM, otosclerosis)
Sensorineural (perceptive) hearing loss
CN VIII
pathology of Inner Ear, CN VIII, or Auditory areas of Cerebral Cortex (i.e. presbycusis, ototoxic drugs, brain injury)
presbycusis
Sensorineural hearing loss that affects the middle ear structures or causes damage to the nerve cells in the inner ear or CN VIII (gradual nerve degeneration)
affects men more than women (whites and Hispanics)
Otosclerosis
conductive hearing loss in young adults between 20 and 40
Labyrinth in the Inner Ear
constantly feeds imformation to your brain about your position in space
ie. vertigo
Vertigo
labyrinth becomes inflamed and feeds wrong information to the brain creating staggering gait and strong spinning/whirling sensation
sensation of spinning (subjective) or room is spinning (objective)
how to assess an infants ear vs adults ear
adults ear- pull pinna up and back
infants: pull pinna down
Tinnitus
ringing or buzzing in ear
swelling of mastoid process may indicate
ear infection
cone of light on TM
left ear: 7 o’clock
right ear: 5 o’clock
points towards nose
hearing acuity test
whisper test
tuning fork test: weber test and rinne test (more accurate in detecting conductive hearing loss)
Romberg test
assesses the ability of the vestibular apparatus in the inner ear to help maintain standing balance
also assesses intactness of cerebellum and proprioception
hypothalamus funciton
major respiratory center with basic vital functions: temperature, heart rate, blood pressure, appetite, sex drive
spinal cord mediates
reflexes
Pons and medulla
controls respiration
cranial nerve I
sensory
olfactory
smell
cranial nerve II
sensory
optic
sight
cranial nerve III
mixed
oculomotor
pupillary constriction, accommodation, and eyelid opening
cranial nerve IV
motor
trochlear
down and inward movement of eye
cranial nerve V
mixed
trigeminal
muscles of mastication (motor)
sensation of face, scalp, cornea
cranial nerve VI
motor
abducens
lateral movement of eye
cranial nerve VII
mixed
facial
facial muscles, close eye, speech, close mouth (motor)
taste on anterior 2/3 of tongue (sensory)
saliva and tear secretion (parasympathetic)
cranial nerve VIII
sensory
VESTIBULOCOCHLEAR
hearing and equilibrium
cranial nerve IX
mixed
glossopharyngeal
pharynx (phonation and swallowing) (motor)
taste on posterior 1/3 of tongue and gag reflex (sensory)
parotid gland and carotid reflex (parasympathetic)
cranial nerve X
mixed
vagus
pharynx and larynx (talking and swallowing) (motor)
general sensation from carotid body and carotid sinus (sensory)
carotid reflex (parasympathetic)
cranial nerve XI
motor
spinal accessory
movement of trapezius and sternomastoid muscles
cranial nerve XII
motor
Hypoglossal
movement of tongue
aphasia
loss of ability to understand or express speech
ataxia
difficulty with walking and balance, hand coordination
Decerebrate rigidity
upper extremities- stiffly extended, adducted; internal rotation, palms pronated
lower extremities- stiffly extended, plantar flexion, hyperextended back
indicates lesion in the brainstem at midbrain or upper pons
most ominous sign (poor prognosis - brain stem injury or damage)
Decorticate rigidity
upper extremities: flexion of arms, wrist, and fingers; adduction of arms
arms are tight against thorax
lower extremities: extension, internal rotation, plantar flexion
indicates hemispheric lesion of cerebral cortex (at or above the brainstem)
dysphasia
difficult speech
dysphagia
difficultly swallowing
risk for aspiration
cerebellum ataxia
staggering wide-based gait, difficulty with turns, uncoordinated movement (+ rombergs sign)
ataxia: parkinsons disease
motor system dysfunction
tremors/ rigidity/ cogwheel rigidity
facial expression: flat, staring, mask-like/expressionless
posture is stooped, elbows, knees, and hips are flexed. steps are short and shuffling
hemiplegia
one sided paralysis
tic
repetitive twitching (psychogenic or neurological)
tremor
involuntary contraction of opposing muscle groups
may occur at rest or with voluntary movement
important question to ask with head injury
did you loose consciousness and for how long?
phases of seizures
Preictal phase: Aura – subjective sensation that precedes a seizure: it can be auditory, visual, or motor
Ictal phase- time this, how long did it last and what occurred during (do not leave patient, call for help)
Postictal phase- get vitals and assess the patient
expressive (broca) aphasia
pt has difficultly expressing self. Understands us but Speak in broken speech
Receptive (Wernicke) aphasia
sounds like they know what they are taking about, word salad
global aphasia
expressive and receptive aphasia combined, most severe and most common
aging adult: neurological
Atrophy with steady loss of neuron structure in brain and spinal cord
Decreased or absent Achilles reflex, pupillary miosis, irregular pupil shape, and decreased pupillary reflexes
order of neurological exam
Mental Status
Cranial Nerves
Motor Nerves
Sensory
Reflexes
mental status assessment
ABCT
Appearance
Behavior
Cognition
Thought processes
how to test cranial nerve I
olfactory nerve
Test sense of smell in those who report loss of smell, with the person’s eye closed, occlude one nostril and present a familiar aromatic substance
how to test for cranial nerve II
optic nerve
Test visual acuity and visual fields by confrontation- snellen eye chart
how to test Cranial Nerves III, IV, and VI
oculomotor, trochlear, and abducens nerves
Check pupils for size, regularity, equality, direct and consensual light reaction, and accommodation
Assess extraocular movements by cardinal positions of gaze
testing muscle strength
Hand Grasp w/ push-pull
Plantar flexion & Dorsi-flexion w/ resistance
move correct limbs on command
testing cerebellar function
balance test: observe gait
Romberg test
rapid alternating movements (RAM): finger to finger test, finger to nose test, heel to shin test
grading reflexes
4+ very brisk
3+ brisker than average
2+ average / normal
1+ diminished
0 no response
positive babinski reflex
indicates a upper motor neuron lesion (stroke, brain injury, spinal cord injury)
Neurological recheck assessment
Level of Conscioiusness
Motor Function
Pupillary Response
Vital Signs
Glasgow Coma Scale
Glasgow coma scale
define the level of consciousness
A fully alert, normal person has a score of 15
A score of 7 or less reflects a coma
Stroke
Leading cause of long term disability
3rd leading cause of death
Most common symptoms
TIA (short lived) vs stroke (progressively get worse)
biceps reflex tests spinal nerves
C5 and C6
triceps reflex tests spinal nerves
C7 and C8
brachoradialis reflex tests spinal nerves
C5 and C6
quadriceps reflex tests spinal nerves
L2–L4
Achilles reflex tests spinal nerves
L5 - S2
cerebellum
motor coordination, equilibrium and balance
ototoxic drugs can cause
Sensorineural (perceptive) hearing loss (CN VIII)
